Exploring Exploring

Organisational Organisational Culture Culture

Senior Nurse Advisor Clinical Leadership Development Programme

Every enterprise has four Every enterprise has four organisations: the one that organisations: the one that

is written down, the one is written down, the one that most people believe that most people believe exists, the one that exists, the one that

people wished existed, and people wished existed, and finally, the one that the finally, the one that the

organisation really needs.organisation really needs. NHS Chief ExecutiveNHS Chief Executive

Why is culture important?Why is culture important?

• Investigations into recent high profile Investigations into recent high profile problemsproblems

The understanding of the importance of culture change has come from a number of sources, most notably:

Since the inception of the NHS, Since the inception of the NHS, more than 50 NHS public inquiries more than 50 NHS public inquiries have been conducted to address have been conducted to address

catastrophic failures in patient care. catastrophic failures in patient care.

The same 5 The same 5 common themes emerge common themes emerge

from each inquiry.from each inquiry.Walshe & Higgins (2002)Walshe & Higgins (2002)

Disempowerment of Disempowerment of staff and patients staff and patients

Disempowerment of Disempowerment of staff and patients staff and patients

IsolationIsolationIsolationIsolation

Poor Poor communicationcommunication

Poor Poor communicationcommunication

Inadequate Inadequate leadership / leadership /

managementmanagement

Inadequate Inadequate leadership / leadership /

managementmanagementFailure of Failure of systems systems

and and processesprocesses

Failure of Failure of systems systems

and and processesprocesses

Why is culture important?Why is culture important?

• Investigations into recent high profile Investigations into recent high profile problemsproblems

• A growing awareness that a history of A growing awareness that a history of structural changes has not always structural changes has not always improved servicesimproved services

The understanding of the importance of culture change has come from a number of sources, most notably:

It is the culture, the informalIt is the culture, the informalpsychological and social aspects psychological and social aspects

of an organisation that influences of an organisation that influences how people think, what they see as how people think, what they see as

important, how they behave and important, how they behave and which ultimately determines the which ultimately determines the success of structural reforms.success of structural reforms.

(Cameron and Quinn, 1999)

Why is culture important?Why is culture important?

• Investigations into recent high profile Investigations into recent high profile problemsproblems

• A growing awareness that a history of A growing awareness that a history of structural changes has not always improved structural changes has not always improved servicesservices

• Research has shown the importance of Research has shown the importance of culture in contributing towards high quality culture in contributing towards high quality patient outcomespatient outcomes

The understanding of the importance of culture change has come from a number of sources, most notably:

Case StudyCase Study

In a study of over 5,000 intensive care In a study of over 5,000 intensive care patients, it was found that therepatients, it was found that there

were significant differences in the were significant differences in the deaths of patients between hospitals, deaths of patients between hospitals,

despite the hospitals having similar despite the hospitals having similar levels of funding and staff, and levels of funding and staff, and

serving similar populations. These serving similar populations. These differences appeared to relate to thedifferences appeared to relate to the

quality of interaction and communication quality of interaction and communication between healthcare professionals, two between healthcare professionals, two important aspects of organisational culture.important aspects of organisational culture.

(Knaus, 1986)(Knaus, 1986)

What is culture?What is culture?

• Culture is about how things are done within the workplace (Team Culture Q)

• The way things are done within a team is heavily influenced by shared ‘unwritten rules’

• Cultures reflect what has worked 'well' in the past (Who defines what approach works ‘well’ and should be repeated?)

An Improvement CultureAn Improvement Culture

• Patient CenterednessPatient Centeredness

• Belief in human potentialBelief in human potential

• Innovation and change are encouragedInnovation and change are encouraged

• Recognition of the value of learningRecognition of the value of learning

• Effective team workingEffective team working

• CommunicationCommunication

• Honesty and trustHonesty and trust

An improvement culture can be judged by the extent to which An improvement culture can be judged by the extent to which these aspects are shared and lived by the people within the team. these aspects are shared and lived by the people within the team.

How to understand How to understand your own cultureyour own culture

• Using metaphors and frameworks

• Gaining a deeper understanding

• Why the culture of a team continues, despite it being unhelpful

• Increase your cultural awareness (C. A’ness Q)

Is your culture helpful?

• Change and learningChange and learning

• PowerPower

• IdentityIdentity

• ConflictConflict

Vital Signs Vital Signs (Q)(Q)

Building and nurturing a culture of improvement

When building a culture of improvement, When building a culture of improvement, you need to work like a farmer, planting you need to work like a farmer, planting

seeds and nourishing the ground. seeds and nourishing the ground. This is distinct from working like This is distinct from working like a car mechanic, who replaces a car mechanic, who replaces

faulty parts with new ones. faulty parts with new ones.These new parts do not always work These new parts do not always work well with the old engine and often well with the old engine and often

cause the whole car to break down! cause the whole car to break down!

(Marshall, 2002)(Marshall, 2002)

Basic PrinciplesBasic Principles

• Actions speak louder than wordsActions speak louder than words• Ensure the right kind of people to deliver Ensure the right kind of people to deliver

the required changesthe required changes• People live what they have helped to People live what they have helped to

createcreate• Say what is not saidSay what is not said• Recognising and understanding Recognising and understanding

‘polarities’

Four Steps to Building Four Steps to Building an Improvement Culture an Improvement Culture

• Decide what needs to change and Decide what needs to change and what needs to stay the samewhat needs to stay the same

• Describe what an ‘improvement Describe what an ‘improvement culture’ means and doesn’t meanculture’ means and doesn’t mean

• Define the new ways of doing things Define the new ways of doing things in terms of practicein terms of practice

• Test out news ways of workingTest out news ways of working

Every enterprise has four Every enterprise has four organisations: the one that organisations: the one that

is written down, the one is written down, the one that most people believe that most people believe exists, the one that exists, the one that

people wished existed and people wished existed and finally, the one that the finally, the one that the

organisation really needs.organisation really needs. NHS Chief ExecutiveNHS Chief Executive

What am I going to do What am I going to do

to contribute to theto contribute to the ‘improvement ‘improvement culture’culture’

of my of my organisation?organisation?

Final Final

ThoughtsThoughts

What am I What am I (are we)(are we)

going to going to dodo differently differently

after today?after today?

If we always do If we always do what we’ve what we’ve always done… always done…

……we’ll always we’ll always get what we’ve get what we’ve always got!always got!

The The ‘Trim Tab’‘Trim Tab’ effect effect

‘‘Trim Tab’Trim Tab’

HMSHMS

Be a TRIM TABBER!Be a TRIM TABBER!

and and finally…finally…

……we’ll probably we’ll probably do nothing about it!do nothing about it!

If we do nothing If we do nothing about it in 24 hours… about it in 24 hours…

Thank YouThank You

DiolchDiolchWebsite: www.ctrtraining.co.ukWebsite: www.ctrtraining.co.uk

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